Immediate postoperative care involves monitoring airway, consciousness, vital signs, pain, and surgical site. Nurses assess for complications, manage IV fluids, and support recovery essential for preventing shock, infection, and delayed healing after surgery.
Introduction
The immediate postoperative phase is a crucial period after surgery in which special attention and care is necessary due to the compromised state of the patient following anesthesia, surgical intervention, and other associated bodily changes. The surgical nurse plays a vital role in the systematic monitoring and care of patients to ensure their speedy recovery without any complications.
Definition
Immediate postoperative care refers to the nursing care provided to the patients in the first 24 hours after surgery starting from the time the patient is shifted to the post-anaesthesia care unit (PACU) or recovery room.
Purposes
- Maintaining adequate body system functions.
- Restoring body homeostasis.
- Pain and discomfort alleviation.
- Preventing postoperative complications.
- Promoting adequate discharge planning and health teaching.
Phases of Immediate Postoperative Care
Phase I: Immediate Post-anesthesia Period
This is the period when the patient is emerging from anesthesia.
- The level of consciousness (LOC), breath sounds, respiratory effort, and oxygen saturation is assessed.
- ECG and more intense monitoring (e.g., arterial BP, cardiac rhythm, and muscle strength) is essential.
- Goal: Preparing the patient for transfer to phase II, ICU, or an inpatient unit.
Phase II: Continued Recovery
- The patient’s consciousness returns to baseline and the patient has stable pulmonary, cardiac, and renal functioning.
- Some patients may directly go from the operating room to phase II. This is called fast-tracking.
- Goal: Prepare the patient for transfer to extended observation, home, or extended care facility.
Phase III: Extended Observation
- Ongoing care for patients in an extended care or observation unit.
- Goal: Preparing the patient for self-care.
Common Postoperative Complications
Immediate
- Hypothermia.
- Shock.
- Primary bleeding.
- Wound or anastomotic dehiscence.
- Bronchopleural fistula.
- Aspiration.
- Acute lung injury.
- Hemothorax.
- Pulmonary edema.
- Basal atelectasis.
- Acute myocardial ischemia.
- Arrhythmia.
- Anesthesia-related complications such as acute confusion, nausea, vomiting, spinal headache, and malignant hyperthermia.
- Paralytic ileus.
- Bowel obstruction.
- Acute urinary retention
Late
- Deep vein thrombosis.
- Stroke.
- Pneumonia.
- Pulmonary embolism.
- Skin/wound infection/evisceration/delayed healing.
- Urinary tract infection.
- Sepsis.
- Functional: Weakness, fatigue, and functional decline.
Postoperative Nursing Interventions
Patient Assessment
- Assess air exchange status and note the patient’s skin color.
- Verify the patient’s identity. The nurse must also know the type of operative procedure performed and the name of the surgeon responsible for the operation.
- Neurological status assessment: The LOC assessment and Glasgow Coma Scale (GCS) are helpful in determining the neurological status of the patient.
- Cardiovascular status assessment: This is performed by determining the patient’s vital signs in the immediate postoperative period and skin temperature.
- Operative site examination: Dressings should be checked.
Positioning
- Cover the patient with blankets and secure with straps above the knees and elbows when transferring the patient to the stretcher.
- Keep side rails elevated to protect the patient from falls.
- Follow safety check when transferring the patient from the operating room to the recovery room or PACU.
- S: Secure restraints for IV fluids and blood transfusion.
- A: Assist the patient to the appropriate position based on the location of incision and presence of draining tubes.
- F: Fall is prevented by appropriate use of restraints and side rails.
- E: Eliminate possible sources of injuries and accidents when shifting the patient.
The mnemonic “POSTOPERATIVE” can be applied:
- P: Preventing and/or relieving complications.
- O: Optimal respiratory function.
- S: Support-psychosocial well-being.
- T: Tissue perfusion and cardiovascular status maintenance.
- O: Observing and maintaining adequate fluid intake.
- P: Promoting adequate nutrition and elimination.
- E: Encouraging activity and mobility within limits.
- R: Renal function maintenance.
- A: Adequate fluid and electrolyte balance.
- T: Thorough wound care for adequate wound healing.
- I: Infection control.
- V: Vigilant to manifestations of anxiety and promoting ways of relieving it.
- E: Eliminating environmental hazards and promoting patient safety.
Special Considerations
- Elderly patients: Monitor for delirium, hypothermia, and slower drug metabolism
- Diabetic patients: Frequent glucose checks to prevent hypo/hyperglycemia
- Cardiac patients: Watch for arrhythmias, fluid overload, and ischemia
- Post-anesthesia effects: Grogginess, confusion, respiratory depression
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
